The patient is a 93 year old female with dementia, hypertension and high blood pressure.
Initial presentation: Poor appetite and oral intake; Unintentional weight loss and confusion. Frequent urinary tract infections (UTIs).
Weight loss: 13.6% (8kg) in 6 months.
Malnutrition Universal Screening Tool (MUST) score: 2.
|Bisoprolol||For blood pressure control|
|Atorvastatin||For lipid (cholesterol) management|
|Memantine||For dementia/Alzheimer’s disease management|
800kcal, 26g protein, 850ml fluid daily.
Lives with family member who has limited cooking skills. Has good additional family support.
Aim was to meet the patient’s nutritional requirements and prevent further weight loss.
At initial assessment, the patient’s intake and nutritional requirements were calculated.
Deficit = 730kcal, 35g protein, 680ml fluid daily.
Rationale for nutrition support was discussed with family member. The family expressed concerns with regards to adding more fat into the patient’s diet due to her raised cholesterol level. The importance of increasing the patient’s energy intake to meet her nutritional requirements was explained.
The above advice, if all implemented, was expected to increase the patient’s intake by 800kcal and 30g protein daily.
Family supported the patient with all agreed steps in the plan, however the patient refused the following:
Intake was calculated at 1250kcal and 45g protein daily, leaving a deficit of 280kcal and 16g protein daily.
Weight had reduced further to 49.5kg, BMI 20.9kg/m2.
At this stage it was felt that dietary changes had been maximised and trialling ‘compact style’ oral nutritional supplements (ONS) was appropriate. A prescription was organised to enable a variety of ONS for the patient to trial.
Family member reported that patient had refused all of the oral nutritional supplements trialled due to a dislike of the flavours.
A trial of Pro-Cal shot (neutral flavour) was organised. The patient was advised to try 3 x 40ml per day (providing 400kcal, 8g protein).
Family member reported that the patient was tolerating Pro-Cal shot and felt that, as it was given in small volumes throughout the day, it was manageable for the patient.
The patient continued with the agreed dietary changes and was managing 3 x 40ml Pro-Cal shot per day.
Family had initial concerns regarding nutrition support advice due to the patients high cholesterol level and family’s personal preference of using low fat products. However when the rationale for changes were explained, the family were agreeable to the plan.
This patient had a very poor fluid intake despite constant encouragement from her family, so a low volume ONS was required. The patient disliked the flavours of other ‘compact style’ supplements and so a neutral flavour supplement was beneficial. Pro-Cal shot was deemed an appropriate supplement as it is low volume and available in a neutral flavour.
A high energy, high protein diet alongside Pro-Cal shot enabled the patient to meet nutritional requirements and stabilised weight.